Provider Demographics
NPI:1104452416
Name:PADRON, AARON
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:PADRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 RAINBOW DR # 10486
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-2004
Mailing Address - Country:US
Mailing Address - Phone:206-620-1222
Mailing Address - Fax:559-236-0110
Practice Address - Street 1:204 RAINBOW DR # 10486
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77399-2004
Practice Address - Country:US
Practice Address - Phone:908-208-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC004069363LP0808X
TXAP145519363LF0000X
NH086453-23363LP0808X
CA95014324363LP0808X
WAAP61115995363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily